TwinFix锚钉胫后肌腱重建术治疗成人足副舟骨疼痛综合征并发症发生原因及防治策略  

Analysis of Causes and Prevention Strategies of Complications for Adult Patients with Painful Accessory Navicular Pain Syndrome Treated with Posterior Tibial Tendon Reconstruction Using TwinFix Anchor

作　　者：王宇清 金瑞娜 康强军 WANG Yuqing;JIN Ruina;KANG Qiangjun(The Third Department of Orthopedics,the 980th Hospital of Joint Logistics Support Force of the PLA,Shijiazhuang 050082,China)

机构地区：[1]联勤保障部队第九八〇医院骨三科,石家庄050082

出　　处：《临床误诊误治》2025年第6期55-59,67,共6页Clinical Misdiagnosis & Mistherapy

基　　金：联勤保障部队战勤部面上项目(CLB19J044)。

摘　　要：目的探讨TwinFix锚钉胫后肌腱重建手术治疗成人足副舟骨疼痛综合征并发症发生的原因及防治策略。方法回顾性分析2013年1月至2023年1月行TwinFix锚钉胫后肌腱重建术治疗的成人足副舟骨疼痛综合征出现并发症的32例的临床资料。结果32例中发生术后疼痛12例(37.5%),其中,切口、切口周围及足内侧其他区域疼痛10例,锚钉误入关节及钉尾外露刺激皮肤各1例,经过抗感染、消肿、止痛等对症治疗或手术翻修治疗后,症状均缓解;发生周围神经损伤相关足底麻木5例(15.6%),行消肿和营养神经对症治疗,症状好转;术后切口感染、皮肤坏死3例(9.4%),经抗感染治疗并行切口扩创手术后,感染得到控制,切口痊愈;足部功能受限9例(28.1%),经康复锻炼,症状缓解;锚钉脱出3例(9.4%),经二次手术翻修和康复锻炼后,患者病情均好转。术后12个月,美国足与踝关节协会踝-后足功能评分[(86.03±4.83)分]均较术前[(49.34±8.41)分]显著改善(P<0.01)。结论TwinFix锚钉胫后肌腱重建术治疗成人足副舟骨疼痛综合征可发生症状相关并发症及术后功能改善不良相关并发症,与手术时间长、操作粗暴、锚钉脱出等有关,术中应仔细操作,尽量缩短手术时间,术后对出现的并发症积极处理,可避免严重后果。Objective To investigate the causes and prevention strategies of complications in the treatment of adult patients with painful accessory navicular syndrome treated with posterior tibial tendon reconstruction using TwinFix anchor.Methods The clinical data of 32 adult patients with painful accessory navicular syndrome who underwent posterior tibial tendon reconstruction using TwinFix anchor from January 2013 to January 2023 were retrospectively analyzed.Results Postoperative pain occurred in 12 of the 32 patients(37.5%),including pain in the incision,around the incision and other areas of the medial foot in 10 patients,and the anchor strapping into the joint and the exposed nail tail irritating the skin in 1 patient respectively.After symptomatic treatment such as anti-infection,detumescence,pain relief or surgical revision treatment,the symptoms were relieved.Peripheral nerve injury-related plantar-numbness occurred in 5 patients(15.6%),and the symptoms were improved after symptomatic treatment including detumescence and nutritional nerve.Postoperative incision infection and skin necrosis were found in 3 patients(9.4%).The infection was controlled and the incision healed after anti-infection treatment and incision expansion surgery.There were 9 patients(28.1%)with limited foot function,and symptoms were relieved after rehabilitation exercise.There were 3 patients(9.4%)of anchor loss.After the second operation and rehabilitation exercise,the patients'condition improved.At 12 months after operation,AOFAS ankle-posterior foot function score[(86.03±4.83)points]was significantly improved compared with that before operation[(49.34±8.41)points](P<0.01).Conclusion Posterior tibial tendon reconstruction using TwinFix anchor in the treatment of adult patients with painful accessory navicular syndrome can cause symptom-related complications and complications related to poor postoperative function improvement,which are related to long duration of operation,rough operation and anchor loss.Careful operation should be performe

关 键 词：疼痛性副舟骨 TwinFix锚钉 胫后肌腱重建术 手术后并发症 感染 疼痛 神经损伤 AOFAS踝-后足功能 

分 类 号：R681[医药卫生—骨科学]